Reductions in cortical and trabecular bone mass have been documented in young women with hyperprolactinemic amenorrhea. It is unknown whether trabecular osteopenia is progressive or reversible with treatment of hyperprolactinemia. In addition, it is not known whether clinical or hormonal variables can predict trabecular bone density (BD) changes. Therefore, we investigated prospectively trabecular BD by computed tomography in 52 hyperprolactinemic women and 41 controls. The mean follow-up interval was 1.8 +/- 0.1 (SEM) yr. Patient groups were defined as follows: group 1, amenorrhea during the entire study; group 2, restoration of menses during the study by treatment of hyperprolactinemia; group 3, regular menses despite hyperprolactinemia, with no history of prior amenorrhea; group 4, history of prior amenorrhea, but menses restored with treatment of hyperprolactinemia before study entry; and group 5, oligomenorrhea. Groups 1, 2, and 4 had significant (P = 0.0006) initial spinal osteopenia [mean BD 141 +/- 7 (SEM), 144 +/- 9, and 151 +/- 5 mg/cc K2HPO4, respectively] compared with controls or with group 3 (170 +/- 4 and 173 +/- 8 mg/cc K2HPO4, respectively). Group 5 had an initial mean BD which was midway between that of the amenorrheic and eumenorrheic women (156 +/- 13 mg/cc K2HPO4). Group 1 had a significant (P = 0.04) decrease in mean BD to 132 +/- 8 mg/cc K2HPO4 over 1.7 +/- 0.2 yr, with BD in 42% of the group more than 2 SD below the control mean at the final study point. The mean BD in group 2 increased to 155 +/- 9 mg/cc K2HPO4, approaching significance (P = 0.07) when compared with the initial BD. Five of the nine patients in this group (56%) had an increase in BD greater than the variation expected for the computed tomography technique. However, 44% of the group 2 patients had a spinal BD which remained more than 1 SD below the normal mean. There was no change in BD in the other groups.(ABSTRACT TRUNCATED AT 400 WORDS)
ABSTRACT. To assess sleep-associated changes in gonadAbbreviations otropin-releasing hormone secretion during sexual maturation, we studied nighttime and daytime patterns of LH and FSH secretion in two groups with qualitatively similar sex steroid levels: girls with central precocious puberty and young adult women in the early follicular phase of an ovulatory menstrual cycle. In the girls with central precocious puberty, all indices of LH secretion were significantly higher at night than during the day (mean L H levels, 12 f 2 versus 5 f 1 IUIL, p 5 0.01; LH pulse amplitude 16 f 2 versus 7 f 1 IU/L, p 5 0.01; and LH pulse frequency 0.70 f 0.05 versus 0.35 f 0.08 pulselpatient-h, p 5 0.01).Girls with a history of menses, who were presumably the most mature, lacked this diurnal variability. Mean nocturnal FSH levels were only slightly higher than daytime levels (7.6 f 0.5 versus 7.2 f 0.5 IU/L, p 5 0.05) resulting in alternating periods of L H (nighttime) and FSH (daytime) predominance in this pubertal population. In contrast, the adult women had lower mean gonadotropin levels and LH pulse frequencies at night than during the day (mean LH 7 f 1 versus 10 f 1 IUIL, p 5 0.05; mean FSH 9 f 1 versus 10 f 1 IUIL, p 5 0.05; LH pulse frequency 0.40 f 0.08 versus 0.70 f 0.10 pulse/patient-h, p 5 0.05) and often (six of eight) demonstrated striking suspension of gonadotropin-releasing hormone secretion during sleep. The smaller changes in FSH again resulted in periods of relative LH (daytime) and FSH (nighttime) predominance.GnRH, gonadotropin-releasing hormone CPP, central precocious puberty EFP, early follicular phase DSIP, delta sleep-inducing peptide Sleep is an important neuroendocrine modulator of hypothalamic function. With the onset of puberty, a marked increase in sleep-entrained, GnRH-induced gonadotropin pulses occurs (1). After complete maturation of the reproductive axis, cyclic changes in hypothalamic-pituitary-gonadal axis function result in serum estradiol levels during the EFP of the menstrual cycle that approximate those of girls during puberty. Despite this comparable gonadal steroid milieu, women in the EFP exhibit a strikingly different response to sleep. In contrast to pubertal girls, women in the EFP demonstrate sleep-associated slowing in the frequency of GnRH-induced gonadotropin secretory events (2, 3). To further explore the changing impact of sleep upon neurosecretory dynamics across development, we examined the nighttime and daytime patterns of gonadotropin secretion in 39 girls with idiopathic CPP and contrasted them with those of eight young adult women studied during the EFP of an ovulatory cycle. MATERIALS AND METHODSWhen between-group comparisons were made, the girls with central precocious puberty differed significantly fromPatients. Thirty-nine girls with idiopathic CPP were studied as described below. Patients with neurogenic precocity (i.e. centrally the women in the early follicular phase with respect to mediated precocious puberty with radiographic evidence of a each index gonadotrop...
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